Provider Demographics
NPI:1255362851
Name:SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SHERIDAN MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-765-3700
Mailing Address - Street 1:440 WEST LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-1526
Mailing Address - Country:US
Mailing Address - Phone:406-765-3700
Mailing Address - Fax:406-765-3800
Practice Address - Street 1:440 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-1526
Practice Address - Country:US
Practice Address - Phone:406-765-3700
Practice Address - Fax:406-765-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3100279Medicaid
MT3100279Medicaid